The impact of cigarette prices on smoking onset and cessation: evidence from Vietnam

BACKGROUND

Vietnam is a country with very high smoking rates among men. According to a Global Adult Tobacco Survey (GATS) conducted in 2015, the daily smoking prevalence among Vietnamese men was 39%.

METHODS

We used data from the 2010 and 2015 Vietnamese GATSs and cigarette price data from General Statistics Office of Vietnam. Since smoking prevalence is low among women, we only considered men. Using discrete-time hazard models, we estimated the effect of cigarette prices on smoking onset and cessation. Sensitivity analyses are conducted using different model specifications.

RESULTS

We find that higher cigarette prices reduce the probability of smoking onset. A 1% increase in the cigarette price reduces the hazard of smoking onset by 1.2% (95% CI -2.12% to -0.28%). This suggests that increases in tobacco taxation, which translate to price increases, can reduce smoking onset. We did not find evidence that cigarette prices impact smoking cessation among men in Vietnam.

CONCLUSION

Vietnam should continue to increase excise taxes on tobacco products to reduce smoking onset. Since smokers are resilient to excise tax increases, other tobacco control policies, such as smoke-free areas and tobacco advertisement bans, should be better enforced to encourage people to quit. Other policies not yet implemented, such as plain packaging of tobacco products, may also encourage smokers to quit.

Coverage of safely managed water, sanitation and hygiene: An application of small area estimation

Disaggregated information on welfare indicators is useful for targeted policies. This study constructs geographic maps of water, sanitation, and hygiene (WASH) for provinces and districts in Vietnam (which has 63 provinces and 712 districts). The study finds that poorer provinces and districts tend to have remarkably lower access to safely managed sanitation and water. Provinces in the Northern Midlands and Mountain Areas, and Central Highlands have the lowest level of access to safely managed sanitation and drinking water. There is a great variation in the availability of WASH facilities between districts within the same provinces. Additionally, the study highlights that districts with a higher population of ethnic minorities tend to experience lower rates of access to safely managed sanitation and drinking water. Even within the same district, moreover, ethnic minorities face greater challenges in accessing safely managed sanitation and drinking water compared to the majority Kinh population.

The Crowding-out Effect of Tobacco Expenditure on Health Expenditure: Evidence From a Lower-Middle-Income Country

INTRODUCTION

Poor people have remarkably lower health expenditures than rich people in Vietnam. According to the 2016 Vietnam Household Living Standard Survey (VHLSS), per capita health expenditure of the top quintile households is around 6 times higher than that of the bottom quintile households.

AIMS AND METHODS

We analyze economic inequalities in health expenditure using the concentration index approach and data from the VHLSS 2010-2016. Next, we use the instrumental-variable regression analysis to examine the crowding-out effect of tobacco expenditure on health expenditure. Finally, we use decomposition analysis to explore whether economic inequality in tobacco expenditure is associated with an economic inequality in health expenditure.

RESULTS

We find a crowding-out effect of tobacco expenditure on health expenditure of households. The share of health expenditure of households with tobacco spending is 0.78% lower than that of households without tobacco spending. It is estimated that a one-VND increase in tobacco expenditure results in a 0.18 Vietnamese Dong (VND) (95% CI: -0.30 to -0.06) decrease in health expenditure. There is a negative association between economic inequality in tobacco expenditure and economic inequality in health expenditure. This means that if the poor consume less tobacco, their expenditure on health can be increased, resulting in a decrease in inequality in health expenditure.

CONCLUSIONS

Findings from this study suggest that reducing tobacco expenditure could improve health care of the poor and reduce inequality in health care in Vietnam. Our study recommends that the government continuously increase the tobacco tax in order to effectively reduce tobacco consumption.

IMPLICATIONS

Empirical studies show mixed results on the effect of tobacco expenditure on health expenditure. We find a crowding-out effect of tobacco expenditure on health expenditure of poor households in Vietnam. It implies that if the poor reduce their expenditure on tobacco, economic inequality in health expenditure can be reduced. Our findings suggest that reducing tobacco consumption in poor households can increase their health expenditure, therefore, decreasing inequality in health expenditure. Different policies to reduce tobacco consumption such as tobacco taxation, smoke-free areas, and tobacco advertisement bans should be strengthened.

Inequality in electricity consumption and economic growth: Evidence from a small area estimation study

Our study uses a small area estimation method to estimate the average and inequality of per capita kWh consumption for small areas in Vietnam. It shows evidence of a large spatial heterogeneity in the electric power consumption between districts and provinces in Vietnam. Households in the mountains and highlands consumed remarkably less electricity than those in the delta and coastal areas. Notably, we find a U-shaped relationship between the inequality of electricity consumption and economic levels in Vietnam. In poor districts and provinces, there is very high inequality in electricity consumption. Inequality is lower in middle-income districts and provinces.

The impact of cold waves and heat waves on mortality: Evidence from a lower middle-income country

We estimate the impact of temperature extremes on mortality in Vietnam, using daily data on temperatures and monthly data on mortality during the 2000-2018 period. We find that both cold and heat waves cause higher mortality, particularly among older people and those living in the hot regions in Southern Vietnam. This effect on mortality tends to be smaller in provinces with higher rates of air-conditioning and emigration, and provinces with higher public spending on health. Finally, we estimate economic cost of cold and heat waves using a framework of willingness to pay to avoid deaths, then project the cost to the year 2100 under different Representative Concentration Pathway scenarios.

Acute and sub-acute toxicity evaluation of Merremia tridentata (L.) stem extract on mice

The acute and sub-acute toxicity studies were performed in male and female Swiss albino mice as per the guidelines mentioned in OECD. The oral administration of M. tridentata stem extract (MSE) showed no treatment-related mortality and body weight change in mice up to the single dose of 30,000 mg/kg body weight in the acute toxicity study and up to a dose of 30,000 mg/kg/day body weight in the sub-acute toxicity study. Moreover, the clinical signs, body weight, gross pathology, organ weight, hematology (except for platelet count), biochemical analysis, and histopathology did not show significant variation at a medium dose of 15,000 mg/kg/day body weight compared to the control group. However, toxicological signs in behavior, very mild interstitial nephritis, as well as significant variation in platelet count and total protein parameters were observed at a dose of 30,000 mg/kg/day in the 28-day oral toxicity study. Thus, the no-observed-adverse-effect level was determined at a dose of 15,000 mg/kg/day body weight. Based on study results, it is concluded that MSE showed LD₅₀ of greater than 5000 mg/kg/day body weight. Hence, this could be a potential candidature as a future safe pharmaceutical product.

Did a successful fight against COVID-19 come at a cost? Impacts of the pandemic on employment outcomes in Vietnam

Despite its low middle-income status, Vietnam has been widely praised for its success in the fight against early waves of the COVID-19 pandemic, with a low mortality rate of approximately 100 deaths out of a population of less than 100 million by the end of 2020. We add to the emerging literature on COVID-19 effects on the labor market for poorer countries by analyzing rich individual-level data from Vietnam's Labor Force Surveys spanning 2015 to 2020. We find post-pandemic increases in unemployment and temporary layoff rates alongside decreases in employment quality. Monthly wages declined even as the proportion of workers receiving below-minimum wages substantially increased, contributing to sharply rising wage inequality. Our findings suggest that more resources should be allocated to protect vulnerable workers, especially as the pandemic continues to cause increasingly severe damage to the global economy.

Inequality and support for government responses to COVID-19

Despite a deep literature studying the impact of inequality on policy outcomes, there has been limited effort to bring these insights into the debates about comparative support for government responses to the COVID-19 pandemic. We fill this gap by analyzing rich survey data at the beginning of the pandemic in April 2020 from six countries spanning different income levels and geographical locations—China, Italy, Japan, South Korea, the United Kingdom, and the United States. We find that poorer individuals are less supportive of government responses. Furthermore, poorer individuals residing in more economically unequal countries offer even less government support. We also find that both economic and non-economic factors could affect the poor’s decisions to support stringent government policies. These findings suggest that greater transfers to the poor may offer an option to help increase support for strict policies and may reduce the potential deepening of social inequalities caused by the pandemic.

The effect of preschool attendance on Children's health: Evidence from a lower middle-income country

In this study, we find that children in Vietnam who were born in December of a given year have better health outcomes than those born in January of the following year. Children born in December are taller, heavier, and less likely to be underweight and suffer from stunted growth than those born in January of the following year, though these two groups of children differ in age by only 1 month. We argue that the effect of being born in December compared to January on children's health is translated through early preschool attendance. In Vietnam, children born in December are more likely to start preschool as well as primary school 1 year earlier than those born in January of the following year. Thus, the health benefit for a child born in December would come from earlier and longer exposure to preschool. Importantly, we find that the positive effect of preschool persists over time as children grow. A possible major reason why preschool attendance improves health is the nutrition provided for children in preschools.

In vitro and in vivo antidiabetic activity, isolation of flavonoids, and in silico molecular docking of stem extract of Merremia tridentata (L.)

The antidiabetic activity of stem-ethanol extract (SE) and the flavonoid-rich fraction (FF) of Merremia tridentata (L.) were investigated on alloxan-induced diabetic mice. Apigenin, cosmosiin, and quercitrin are flavonoids isolated for the first time from stem extracts. In addition, cynaroside was found to be at the highest level in SE and FF with a percentage of 4.375% and 58.430%, respectively. The administration of SE (100 mg/kg) and FF (50, 75 mg/kg) daily for 20 days resulted in a better hypoglycemic effect than the reference drugs, glibenclamide (5 mg/kg), and metformin (10 mg/kg). Furthermore, SE and FF were shown to significantly improve the plasma lipid profiles at the end of the study. Docking's study suggests that cynaroside, cosmosiin, and quercitrin are the most desirable compounds for hypoglycemic effects in many antidiabetic targets. Especially, SE and FF showed strongly α-amylase and α-glucosidase inhibitory activities (IC50 = 1.61-1.72 mg/mL on α-amylase and IC50 = 0.24-0.44 mg/mL on α-glucosidase). Therefore, SE and FF of Merremia tridentata is a potential drug with antidiabetic and hypoglycemic action as indicated by in vivo, in silico, and in vitro studies.

The impact of cigarette prices on smoking participation and tobacco expenditure in Vietnam

Vietnam is one of countries with the highest number of smokers in the world and the high smoking prevalence among men in the region. Although the real cigarette prices increased by around 4% during the 2010-2015 period, the prevalence of daily cigarette smoking among men decreased slightly from 31.3% to 30.7% during this period. This raises the question of whether cigarette consumption is sensitive to price. In this study, we estimated the effect of cigarette prices on smoking participation and tobacco expenditure in Vietnam. We found that a one-percent increase in the real cigarette price reduced the probability of cigarette smoking among males by 0.08 percentage points (95% CI from -0.06 to -0.10), equivalent to the price elasticity of the smoking prevalence at -0.26 (95% CI from -0.16% to -0.33%). Using this estimate, we predict that if the cigarette price is increased by 10%, the daily cigarette smoking prevalence among men would decrease from 30.7% to 29.9% and the number of male smokers would decline by around 270 thousand. Higher cigarette prices also reduced per capita tobacco expenditure of households. A one-percent increase in the cigarette price decreased per capita expenditure on tobacco consumption expenditure of households by 0.43 percent (the 95% CI from -0.029 to 0.822). This finding suggests that raising tobacco taxes and prices can be an effective measure to reduce tobacco use.

Gender inequality during the COVID-19 pandemic: Income, expenditure, savings, and job loss

The COVID-19 outbreak has brought unprecedented disruptions to the global economies and has led to income loss and high unemployment rates. But scant, if any, evidence exists on gender gaps in economic outcomes such as income, expenditure, savings, and job loss in a multi-country setting. We investigate the impacts of COVID-19 on gender inequality in these outcomes using data from a six-country survey that covers countries in different geographical locations and at various income levels. Our findings suggest that women are 24 percent more likely to permanently lose their job than men because of the outbreak. Women also expect their labor income to fall by 50 percent more than men do. Perhaps because of these concerns, women tend to reduce their current consumption and increase savings. Factors such as the different participation rates in work industries for men and women may take an important part in explaining these gender gaps. Our estimates also point to country heterogeneity in these gender differences that is likely due to varying infection rates and shares of women in the labor force.

Are migrants in large cities underpaid? Evidence from Vietnam

This paper examines the wage gap between migrants and non-migrants in large cities in Vietnam. It finds that migrants receive substantially lower wages than non-migrants. The wage gap tends to be larger for older migrants. However, once observed demographic characteristics of workers are controlled, there are no differences in wages between migrants and non-migrants. The main difference in observed wages between migrants and non-migrants is explained by differences in age and education between migrants and non-migrants.

JEL Classification: O15, R23, I32

Does parental migration really benefit left-behind children? Comparative evidence from Ethiopia, India, Peru and Vietnam

Millions of children are left behind when their parents migrate from home to another place. This study examines whether parental migration can affect health and cognitive ability of left-behind children aged at 5-8 years old in Ethiopia, India, Peru, and Vietnam. It uses data on 7725 children in the four countries collected from Young Lives surveys in 2007 and 2009. It finds that although parental migration helps families increase per capita consumption, it does not improve health and cognitive ability of children. The effect of parental migration varies across different countries and different types of migration. In Ethiopia, parental migration does not have a significant effect on children. However, parental migration reduces health outcomes of children in other three countries and decreases cognitive ability test scores in India and Vietnam. The negative effect on children tends to be higher for long-term parental migration than short-term parental migration.

The impact of voluntary health insurance on health care utilization and out-of-pocket payments: new evidence for Vietnam

Vietnam aims to achieve full coverage of health insurance in 2015. An increasing type of health insurance in Vietnam is voluntary health insurance. Although there are many studies on the implementation of voluntary health insurance in Vietnam, little is known on the causal impact of voluntary health insurance. This paper measures the impact of voluntary health insurance on health care utilization and out-of-pocket payments using Vietnam Household Living Standard Surveys in 2004 and 2006. It was found out that voluntary health insurance helps the insured people increase the annual outpatient and inpatient visits by around 45% and 70%, respectively. However, the effect of voluntary health insurance on out-of-pocket expenses on health care services is not statistically significant.

Atypical and columnar cell lesions in breast needle biopsies for indeterminate microcalcifications: predictors of higher risk findings requiring surgical excision

Abstract #3004

Background: Columnar cell lesions (CCL) are frequently identified in biopsies performed for calcifications. The primary objective of this study is to identify histologic features of CCL in directional vacuum-assisted needle biopsies (DVAB) that could predict a higher risk lesion requiring excision.
 Design: From June 2002 to January 2008, we retrieved the materials for 88 DVABs and their subsequent segmental resections. We excluded carcinomas, intraductal papillomas, fibroadenomas, adenosis, or radial scars. Using World Health Organization criteria, CCLs were classified as CCL with no atypia (CCL-NA), CCL with cytologic atypia (CCL-CA; flat epithelial atypia), or architectural atypia/atypical ductal hyperplasia (CCL-ADH) in the background of CCL. In cases with atypia, the involved terminal duct lobular units/ducts (TDLUs) were quantified. Atypical cases were separated two groups as follows: minimal ADH (≤2 TDLU and minimal cytologic atypia) and extensive ADH/borderline DCIS (≥3 TDLU and/or significant cytologic atypia bordering on DCIS).Radiographs were evaluated to assess amount of calcifications removed. Biopsy results were correlated with the subsequent surgical excision results.
 Results: Eight of 88 biopsies were excluded because of overdiagnosis or because the lesions were not associated with microcalcifications. The remaining 80 biopsies included 5 cases of CCL-NA, 4 pure CCL-CA, 20 mixed CCL-CA + ADH and 51 pure CCL-ADH. Microcalcifications were identified in association with the targeted lesions. There were no higher risk findings in any of the resection specimens with CCL-NA and pure CCL-CA. Ten of the atypical lesions showed carcinoma on excision (9 DCIS and 1 invasive cancer). Twenty-five percent (9/36) extensive ADH/borderline DCIS showed carcinoma on excision. In contrast, only 2.5% (1/39) of minimal ADH cases showed carcinoma on excision. Radiologic review revealed residual abnormality in this one case.
 Conclusion: In summary, the extent of lobular involvement by atypia (CCL-CA or CCL-ADH) correlated with the presence or absence of higher risk lesions upon subsequent excision. These results suggest that additional surgery may not be necessary for CCL-CA or CCL-ADH that is limited to ≤ 2 foci provided sampling of the microcalcifications is adequate.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3004.

Peeling force spectroscopy: exposing the adhesive nanomechanics of one-dimensional nanostructures

The physics of adhesion and stiction of one-dimensional nanostructures such as nanotubes, nanowires, and biopolymers on different material substrates is of great interest for the study of biological adhesion and the development of nanoelectronics and nanocomposites. Here, we combine theoretical models and a new mode in the atomic force microscope to investigate quantitatively the physics of nanomechanical peeling of carbon nanotubes and nanocoils on different substrates. We demonstrate that when an initially straight nanotube is peeled from a surface, small perturbations can trigger sudden transitions between different geometric configurations of the nanotube with vastly different interfacial energies. This opens up the possibility of quantitative comparison and control of adhesion between nanotubes or nanowires on different substrates.

Complex dynamics of carbon nanotube probe tips

Carbon nanotube (CNT) tips in tapping mode atomic force microscopy (AFM) enable very high-resolution imaging, measurements, and manipulation at the nanoscale. We present recent results based on experimental analysis that yield new insights into the dynamics of CNT probe tips in tapping mode AFM. Experimental measurements are presented of the frequency response and dynamic amplitude-distance data of a high-aspect-ratio multi-walled (MW) CNT tip. Higher harmonics of the microcantilever are measured in frequency ranges corresponding to attractive regime and the repulsive regime where the CNT buckles dynamically. Surface scanning is performed using a MWCNT tip on a SiO(2) grating to verify the imaging instabilities associated with MWCNT buckling when used with normal control schemes in the tapping mode. Lastly, the choice of optimal setpoints for tapping mode control using CNT tip are discussed using the experimental results.

A history of low back injury is a risk factor for recurrent back injuries in varsity athletes

In this prospective study, we investigated whether a history of previous low back injury and dissatisfaction with a coach and teammates could predict future low back injury in varsity athletes during a 1-year follow-up period. Of 679 Yale varsity athletes surveyed in 1999, 18.3% (124) reported that they had sustained a low back injury within the past 5 years, and 6.8% (46) sustained a low back injury in the follow-up season. There were no differences in incidence rates between men and women or between athletes involved in contact or noncontact sports. A history of low back injury was the significant predictor for sustaining low back injury in the following year, and athletes who reported previous low back injury were at three times greater risk. Athletes who still had pain at the time of the survey were six times more likely to sustain a low back injury than were athletes without a history of low back injury. These results suggest that some risk factors associated with a history of low back injury predispose athletes to sustain recurrent injury. They may be congenital or a result of insufficient recovery time after the first low back injury episode.

Immunogenicity and safety of low-dose intradermal rabies vaccination given during an Expanded Programme on immunization session in Viet Nam: results of a comparative randomized trial

The World Health Organization recently recommended a rabies vaccine pre-exposure schedule using 3 intradermal (i.d.) injections of one-fifth the standard intramuscular (i.m.) dose of current cell culture vaccines as a cost-reducing alternative for developing countries. As a strategy to improve further the acceptability of childhood rabies immunization, we assessed, in a controlled, randomized trial performed in 240 Vietnamese infants, the possibility of associating i.d. administration of a one-fifth dose of purified Vero-cell rabies vaccine (PVRV) with routine Expanded Programme on Immunization vaccines given at 2, 3 and 4 months of age (diphtheria, tetanus, whole-cell pertussis and inactivated poliomyelitis combined vaccine, DTP-IPV). Safety and immunogenicity results were compared with a group of infants given 2 i.m. doses of PVRV (2, 4 months) in association with DTP-IPV (2, 3, 4 months). After i.d. injection, more infants experienced local reactions, particularly redness, but these reactions were generally mild and transient. The rate of systemic reactions was the same in both groups. Although the rabies antibody titres (rapid fluorescent focus inhibition test) were higher 1 month after the third vaccine dose in the i.m. group (30.6 IU/mL vs 12.0 IU/mL in the i.d. group), all infants in both groups had achieved WHO-acceptable protective antibody titres (> or = 0.5 IU/mL) at this time. There was no evidence for any interference between DTP-IPV and rabies vaccine, supporting the interest of a low-dose i.d. PVRV pre-exposure regimen in infants living in rabies-endemic developing countries.

Randomised feasibility trial of pre-exposure rabies vaccination with DTP-IPV in infants

BACKGROUND

Pre-exposure vaccination against rabies generally simplifies treatment and could be especially beneficial to children in countries where the disease is enzootic. We studied the feasibility of administering to infants pre-exposure rabies vaccination with combined diphtheria, tetanus, whole-cell pertussis, and inactivated poliomyelitis vaccine (DTP-IPV).

METHODS

84 Vietnamese infants were randomly assigned to groups that received three doses of DTP-IPV vaccine at 2, 3, and 4 months of age alone (n = 43) or with two doses of purified Vero cell rabies vaccine (PVRV) at 2 and 4 months (n = 41). The safety and immunogenicity data of the groups were compared.

FINDINGS

All infants in both groups developed protective antibody concentrations against diphtheria, tetanus, pertussis, and polio. All infants who received the PVRV vaccine developed protective antibody concentrations against rabies. No serious adverse effects were reported, nor did systemic reactions differ between groups.

INTERPRETATION

Administration of PVRV with DTP-IPV proved safe, and elicited what are presumed to be protective antibody concentrations to all antigens in all 41 infants. Confirmation of these results could lead to integration of pre-exposure rabies vaccination into Expanded Programme on Immunisation (EPI) sessions in selected countries where rabies is enzootic.

Deletion mapping on the distal third region of chromosome 1p in multiple endocrine neoplasia type IIA

Multiple endocrine neoplasia type IIA (MEN IIA) syndrome is an autosomal-dominant endocrine disorder that consists of medullary thyroid carcinoma (MTC), pheochromocytoma, and parathyroid hyperplasia. The susceptibility gene to this disorder has been mapped to chromosome 10. However, molecular studies of tumor cells from patients with familial and sporadic MTC and/or pheochromocytoma have shown a high frequency (50%) of abnormalities on chromosome 1p. In the present study, we examined MTC or pheochromocytoma tumor specimens from eight patients (familial and nonfamilial cases) to investigate gene losses on chromosomes 1 and 10 as potential mechanisms for the tumors' development. The patients studies had homozygous genotypes in their leukocyte DNAs for the chromosome 10 marker used in this study, and the patients were, therefore, uninformative. However, the patients were informative for the chromosome 1 markers and five of the patients' tumor-cell DNAs (63%) had allelic deletions at one or multiple loci on chromosome 1p, and one tumor DNA had evidence of possible gene rearrangement; in all six cases, the abnormalities involved the distal third of chromosome 1p. Furthermore, we determined that the common break point for the 1p deletions was at 1p32. These results suggest that a tumor suppressor gene in this defined region is involved in the development/progression of MTC and pheochromocytoma by being either lost or inactivated.

C-myc, N-myc, N-ras, and c-erb-B: lack of amplification or rearrangement in human medullary thyroid carcinoma and a derivative cell line

We investigated the copy number and possible rearrangement of the four protooncogenes, c-myc, N-myc, N-ras, and c-erb-B, in DNA from seven untreated primary cancers or metastases of medullary thyroid carcinoma and an established human medullary thyroid carcinoma cell line, TT, using the Southern blotting technique. The purpose of this study was two-fold: 1) to examine whether protooncogene perturbations in medullary thyroid carcinoma could be considered as a prognostic marker; and 2) to determine whether the protooncogenes could have a possible role in medullary thyroid tumorigenesis. Neither amplification nor rearrangement of the protooncogenes was detectable in the DNA from any tumor samples or in the cell line. Our results suggest that DNA-evident amplification and rearrangement of the c-myc, N-myc, N-ras, and c-erb-B oncogenes may not be mechanisms through which these oncogenes become activated in this malignancy.